Challenges are a catalyst for innovation and telemedicine [virtual consultations] has rapidly developed to meet the constraints of COVID-19. This will become the future norm in clinical practice, but there will still be the need for face-to-face appointments for clinical examination and investigations. The initial virtual consultation streamlines the interaction between the expert and the patient and a face-to-face appointment will only be made if indicated. The performance of a virtual consultation facilitate the assessment of those patients who have difficulties in attending a consultation in person because of health issues, the distance involved, or the availability of transport and will be beneficial in optimizing the expert’s time management.
The COVID-19 pandemic has been a catalyst for the development of modalities for delivering healthcare in order to maintain social distancing and minimize the potential spread of infection, following Public Health England’s recommendation that all non-urgent face-to-face clinical work should be postponed, which includes consultations for medico-legal reports. Mr Peter Gray considers the best practice in relation to medico-legal report writing in this unprecedented time: –
Prior to undertaking any consultation for all medico legal reports, it is my practice to thoroughly review the letter of instruction, any witness statements, the medical records bundle [from general practice and hospital. In ophthalmological cases, the optician’s records including retinal photographs & OCT scans, are invaluable as they detail the ‘pre-event’ and subsequent visual status. These records should be supplied electronically for superior image quality and to prevent contamination in the postal system. This represents the knowledge base for all consultations and will enable both the expert and the patient to engage with each other optimally.
I favour an introductory telephone call because this will be a familiar modality for all patients. This will be fact-finding [utilizing a list of questions drafted after reviewing the disclosed records] as well as requesting items such as photographs]. A future video consultation can be discussed considering accessibility, informed consent, confidentiality and GDPR. A video link further facilitates the verification of the patient’s identity by showing photographic id to the camera. The patient’s location should be confirmed which should be with no other person present, in private, and not in their lawyer’s office. The history will be taken as in a face-to-face consultation together with the interpretation of the patient’s body language, facial expression and tonal changes. The expert has the facility to enlarge the video images to allow a more detailed view. A full examination may be indicated which will require a face-to-face consultation. Because a full history will have been taken during the virtual consultation, the time required for the face-to-face examination will be reduced which will increase the safety for both the expert and the patient. by reducing the number of patients seen and of the time spent in the clinic environment and potential exposure to other sick patients. The client should wear a face covering and the expert PPE to this examination. There is a need to balance the risks associated with the patient travelling to against the benefits of undergoing the face-to-face examination or postponing it to a later date.
The expert should specifically state in his report the modality in which the consultation was conducted and if items, such as photographs and other investigations, are interpreted by the expert, the date of the investigation and where it was performed should be stated. If the expert considers that more up-to-date investigations are required, a provisional report could be drafted with the recommendation that a final report would be produced when the investigations have been performed when possible according to Public Health England’s guidelines. But if the patient complains of a significant change in their clinical status, they should be referred via their GP for management because the role of the expert is to prepare the report for the court and not to manage the patient’s condition. A provisional report should be drafted in such circumstances.